Providers Prep For Possible Health Care Changes

Since the Affordable Care Act became law in the spring of 2010, The Ohio State University Medical Center and Ohio Health have made changes to their health systems. Executives say some the adjustments relate directly to the new law, while other changes were already in the works. One major change involves record keeping. The health care law requires hospitals to have electronic medical records. The goal is to reduce medical errors and cuts costs. The OSU Medical Center finished its conversion to electronic records last year. But CEO Dr. Steven Gabbe said the medical center began planning for the switch in 2008. "Our patients have full access to the electronic medical record, they can see the results of their tests, they can communicate with their doctors and nurses," Gabbe said. E-records also are expected to cut back on duplicate testing. Let's take blood tests for example. Doctors within the same health system would be able to review a patient's record and see blood work results instead of ordering and paying for another blood test. Ohio Health also began integrating electronic records before the law was passed. Now the system is making sure their system matches the law's requirements. Another requirement stands to affect hospitals more. Beginning next year, some hospitals taking part in a pilot program will start to change how they charge patients and insurance companies. Hospitals are encouraged to switch to bundled payments. Right now, if you're on Medicare and you go to the hospital for say, a gall bladder attack, lab fees, radiology fees and doctors' fees all are charged separately. Under a bundle payment, hospitals would receive one flat rate. Ohio Health president and CEO David Blom said the goal is to lower the cost of treatment. "If there's an episode of care that costs $9,000, if the provider community can do it effectively and efficiently for less than $9,000, those dollars are kept by those folks. If it costs more they are at risk for it. So the bundle payment is intended to create the incentives for all parts of the systems to deliver it more efficiently and effectively," Blom said. Neither OSU nor Ohio Health will be taking part in the federal bundle payment pilot program. Ohio Health is reviewing it. But OSU's Steven Gabbe said the system is equipped to handle bundled payments if they're implemented. The new health care law also requires hospitals to cut re-admissions - patients who have to go back to the hospital for preventable follow-up visits. As many as a quarter of people who are hospitalized for serious ailments such as heart attack are back in the hospital within a month of being discharged. Beginning in fiscal year 2013, the health care law would penalize health systems for excessive re-admissions for pneumonia, heart failure and heart attack. OSU's readmission rates are in line with the national average - about 25 percent. Dr. Gabbe said a key component to reducing re-admissions is communication. "If the patient has his or her medications, if they have a follow up visit within a short time…we communicate effectively with their primary care physician in their community we can prevent that readmission," Gabbe said. Gabbe anticipates this readmission penalty will include additional conditions as the law tries to contain costs. Ohio Health's David Blom said he's not worried about the program's penalties. "Yes, there is a revenue issue there but it's not sufficiently concerning for us as we really think about this. We're focused on minimizing the number of re-admissions," Blom said. If the Supreme Court upholds the law, nearly one million additional Ohioans will be eligible for medical care. Both Gabbe and Blom anticipate a shortage of physicians. Blom said Ohio Health has hired more primary care doctors. As the way health care is delivered changes, Blom expects doctors will be spending more time with their patients. "If we can coordinate the care by deeper relationship of a patient with their primary care physician, they can avoid perhaps other steps in the system with specialists because they're dealt with on the front end," Blom said. Gabbe said preventive clinics with pharmacists and nurse practitioners will have to be used more to meet the need. But that won't be enough. "We think we will need to train more physicians. And there's been talk about shortening the length of time students need to be in medical school. We think we need to train more nurses." Gabbe said. But what if the U.S. Supreme Court strikes down the law? Gabbe and Blom maintain their hospitals will continue on the same path to make health care more efficient and effective. "Well we will continue on the same course and follow the same strategic plan that we have today,"Gabbe said. "It won't be for naught. We need to reform the health care system…the economy will not be able to withstand the current escalation of health care costs over the long term," Blom added.